Provider Demographics
NPI:1952645004
Name:WESLEY, VENECIA LETRICE (PT)
Entity Type:Individual
Prefix:MS
First Name:VENECIA
Middle Name:LETRICE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 CRESTWICKE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7262
Mailing Address - Country:US
Mailing Address - Phone:404-374-5711
Mailing Address - Fax:
Practice Address - Street 1:7594 CRESTWICKE CROSSING DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-7262
Practice Address - Country:US
Practice Address - Phone:404-374-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist